title: Complex reconstruction of desmoid tumor resections does not increase desmoid tumor recurrence.
abstract: BACKGROUND
  The propensity of desmoid tumors to develop in scars has led some surgeons to limit the complexity of desmoid defect reconstruction as a strategy for avoiding desmoid recurrence. We hypothesized that desmoid recurrence rates are similar despite the magnitude of reconstruction.
  
  
  METHODS
  We retrospectively compared recurrence rates between patients who underwent reconstruction and patients who underwent primary closure without reconstruction after desmoid tumor resection in consecutive patients for 15 years. Univariate and multivariate regression analyzed associations between patient, tumor, and treatment characteristics and outcomes.
  
  
  RESULTS
  We included 164 consecutive patients (80 [49%] reconstructions vs 84 [51%] primary closures). Mean follow-up duration was 7.1 ± 4.5 years. Patients who underwent reconstruction had more desmoids in an area of earlier trauma or surgery (p < 0.001), greater defect volume (p < 0.01), longer operative time (p < 0.001) and hospital stay (p < 0.001), and more postoperative complications (p = 0.015) compared with the primary closure group. Despite these differences, desmoid recurrence rates were similar for the reconstruction and primary closure groups (30% and 29%, respectively; p = 0.7), as was mean time to tumor recurrence, and no tumors recurred within flap donor sites. Multivariate regression analysis demonstrated the 45F mutation to be the only independent predictor of recurrence (hazard ratio = 1.87; p = 0.04).
  
  
  CONCLUSIONS
  Rates of desmoid recurrence in resection defects are similar for primary closures and complex reconstructions. Therefore, surgeons should not limit the magnitude of reconstructions in an attempt to avoid tumor recurrence. However, given the propensity of desmoids to recur, reconstructions should allow for the possibility of future resections and reconstructions, particularly in tumors with 45F gene mutations.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. pbgarvey@mdanderson.org
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.forename: Justin H
authors.initials: JH
authors.lastname: Booth
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.forename: Kathy A
authors.initials: KA
authors.lastname: Calhoun
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D000328:Adult; D005260:Female; D018222:Desmoid Tumors / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies